DOCSLIB.ORG

Treatment of Insertional Achilles Tendinopathy with Ultrasound-Guided Intrabursal Retrocalcaneal Hyaluronic Acid Injection - a Prospective Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment of Insertional Achilles Tendinopathy with Ultrasound-Guided Intrabursal Retrocalcaneal Hyaluronic Acid Injection - a Prospective Study Treatment of insertional Achilles tendinopathy with ultrasound-guided intrabursal retrocalcaneal hyaluronic acid injection - a prospective study Omer Slevin ( [email protected] ) Meir Medical Center https://orcid.org/0000-0002-9294-525X David Segal Meir Medical Center Nissim Ohana Meir Medical Center Eugene Kots Meir Medical Center Viktor Feldman Meir Medical Center Meir Nyska Meir Medical Center Ezequiel Palmanovich Meir Medical Center Research article Keywords: Achilles tendon, Insertional Achilles tendinopathy, Enthesitis, Retrocalcaneal bursitis, Hyaluronic acid, Ultrasound, Sonography Posted Date: October 1st, 2020 DOI: https://doi.org/10.21203/rs.3.rs-32768/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background Insertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy involving brocartilage changes that resemble osteoarthritic changes in articular cartilage. Thus, our primary goal was to evaluate the effect of hyaluronic acid (HA) injections on IAT. Methods Fifteen IAT ankles (14 patients) were treated with three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of hylan G-F 20 (Synvisc®). Patients answered the "Victorian Institute of Sport Assessment – Achilles" (VISA-A) questionnaire before every injection and on 1 month and 6 months follow-up visits. Univariate analysis was performed to identify differences in functional scores. Results The mean (VISA-A) score improved signicantly following HA injections from 34.8 ± 15.2 (range, 11-63) points before the rst injection to 53.6 ± 20.9 (range, 15-77) points after 1 month, and 50.7 ± 18.6 (20-75) points after 6 months. No adverse drug reactions were noted. Conclusions Three consecutive ultrasound-guided intrabursal retrocalcaneal HA injections were found in our cohort to be benecial in treating IAT. Trial registration NCT02368561. Registered 23 February 2015. https://clinicaltrials.gov/ct2/show/NCT02368561? term=insertional+achilles&draw=2&rank=2 1. Introduction Insertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy, affecting both physically active and non-active individuals [1]. The diagnosis is mainly clinical and is based on posterior heel pain, localized to the insertion of the Achilles tendon, accompanied by local swelling and impaired function [2]. About 20% of the patients suffering from chronic Achilles overuse injury have clinical and histopathological signs of IAT [3]. The pathological process in IAT may also involve a retrocalcaneal bursitis [4]. Signicant histopathological degenerative changes in IAT were found not only in the tendon, but also in the calcaneal brocartilage layers surrounding the distal part of the retrocalcaneal bursa [5]. These degenerative changes were found to resemble changes to articular cartilage that occur in osteoarthritis [5,6]. Furthermore, the inammatory changes, such as retrocalcaneal bursitis, were Page 2/12 suggested to be secondary to the brocartilage degeneration [6]. Those ndings imply that IAT may not be merely an activity-related pathology, but rather a more complex process involving all parts of the enthesis [7-9]. The degenerative component in IAT has recently led researchers to suspect that arthritis-modifying agents, such as hyaluronic acid (HA), may be applicable in the treatment of IAT [5]. Several histological studies that investigated the effects of exogenous HA on enthesopathies have shown that HA can reduce inammatory mediators [10], inhibit cartilage degeneration [11], and promote neovascularization and growth of new sensory nerves [12]. Due to the osteoarthritic-like changes in the brocartilage, mainly in the calcaneal posterior wall, we hypothesized that retrocalcaneal intrabursal HA injections would have a benecial effect on IAT patients. The primary goal of this study was to evaluate the effect of this treatment modality for IAT. The secondary goal was to assess whether IAT can be categorized according to four distinct sonographic ndings and to correlate these ndings with the treatment outcomes. 2. Materials And Methods We conducted a prospective, uncontrolled, single-center study between the years 2015 and 2017. Fifteen IAT cases in 14 patients were treated by three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of high-molecular hylan G-F 20 (Synvisc®; Genzyme Biosurgery, Genzyme Corporation, NJ, USA). Patients were followed in a specialized foot and ankle clinic for at least 6 months. An ethical approval was obtained from the local ethical committee (0082-14 MMC). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All participants signed an informed consent form. Inclusion criteria were a diagnosis of chronic IAT that was established by a foot and ankle orthopedic surgeon, and a rheumatology clinic assessment in which a systemic arthropathy was ruled out. The diagnosis was based on a history of pain at the calcaneal insertion of the Achilles tendon and a physical examination that revealed tenderness in the calcaneal insertion of the Achilles tendon. A mandatory radiographic work-up included an Magnetic resonance imaging (MRI) study of the relevant foot and ankle, by which the soft tissue was evaluated for both insertional and peritendinous edema. Exclusion criteria included previous surgical treatment such as retrocalcaneal osteotomy, retrocalcaneal injection of platelet-rich plasma (PRP) or steroids during the 6 months prior to the enrollment, previous two or more steroids injection, a history of Achilles tendon rupture or a previous calcaneal fracture. During the rst visit to the clinic, detailed demographic data, medical history and previous treatment modalities were documented. A physical examination was performed by one of the two abovementioned authors and the patients were asked to ll out the "VISA-A" questionnaire (see below). All the injections were performed by one experienced radiologist by the following technique: The patients were placed in a prone position with the knee slightly exed. The ultrasound probe was placed transverse to the Achilles tendon and the retrocalcaneal bursa. In the transverse sonographic view, the hypoechoic area (the Page 3/12 retrocalcaneal bursa) was situated between the Achilles tendon and the calcaneus (Figure 1). During the rst test, four different areas were examined to characterize the pathology process: A swelling and irregularity in the retrocalcaneal bursa, representing an inammatory process, an irregularity in the posterior calcaneal wall that represents arthritis, an irregularity in the Achilles tendon that represents tendinitis, and an enthesitis reected as an irregularity in the Achilles tendon insertion (Figure 2). Next, a 21-gauge needle was inserted from the lateral side into a point just anterior to the Achilles tendon and a volume of 1-2 ml of Synvisc® was injected into the retrocalcaneal bursa. The study product is a sterile, nonpyrogenic, elastoviscous uid containing hylans, a derivative of hyaluronan, the sodium salt of hyaluronic acid. Each 2 ml glass syringe of Synvisc® contains 16 mg of hylan G-F 20 (cross-linked hylan polymers; hylan A and B), 17 mg sodium chloride, 0.32 mg disodium hydrogen phosphate, and 0.08 mg sodium dihydrogen phosphate monohydrate. The hyaluronan is extracted from chicken combs and the puried material has an average molecular weight of 6,000 kDa. The dose was adapted according to intrabursal pressure and the procedure was terminated when the retrocalcaneal bursa appeared brimful on the sonographic view. The patients were asked to avoid vigorous exercise during the rst two days following the injection. Thereafter, the patients were instructed to try to return to full activity. For outcome evaluation, we used the Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire [13]. This questionnaire was designed specically to assess the severity of Achilles tendinopathy. The questionnaire is a self-administered form that evaluates pain, function and activity level [13] and has been commonly used to monitor outcomes after different treatment modalities for Achilles tendinopathy. It was previously found to be valid, reliable and clinically relevant [13,14]. The scores range from 0 to 100 points, with higher scores indicative of better function. The minimum clinically important difference (MCID), which is dened as the smallest change on a scale that would be considered important to a patient, has been estimated to be between 6 and 12 points [15,16]. A detailed history of daily and sport activities, physical examination results and physical adverse events were assessed 1 month and 6 months following the primary injection. The patients were asked to answer the VISA-A questionnaire before every injection and on each follow-up visit. 2.1 Statistical analysis Descriptive statistics included means, medians, ranges, and standard deviations calculated for the demographic variables and the VISA-A scores. For evaluation of the difference from the baseline at 1 month and 6 months, we used a two-tailed Mann-Whitney U test for nonparametric variables. The level of signicance was set at p = 0.05. Analyses were performed using IBM SPSS-25 (Chicago, IL) statistical package software. 3. Results The mean age of patients, 12 males and 3 females, was 53.7 ± 11.5 (range,
Load more

Recommended publications
  • Understanding Entheseal Changes: Definition and Life Course Changes Sébastien Villotte, Christopher J
    Understanding Entheseal Changes: Definition and Life Course Changes Sébastien Villotte, Christopher J. Knüsel To cite this version: Sébastien Villotte, Christopher J. Knüsel. Understanding Entheseal Changes: Definition and Life Course Changes. International Journal of Osteoarchaeology, Wiley, 2013, Entheseal Changes and Occupation: Technical and Theoretical Advances and Their Applications, 23 (2), pp.135-146. 10.1002/oa.2289. hal-03147090 HAL Id: hal-03147090 https://hal.archives-ouvertes.fr/hal-03147090 Submitted on 19 Feb 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. International Journal of Osteoarchaeology Understanding Entheseal Changes: Definition and Life Course Changes Journal: International Journal of Osteoarchaeology Manuscript ID: OA-12-0089.R1 Wiley - ManuscriptFor type: Commentary Peer Review Date Submitted by the Author: n/a Complete List of Authors: Villotte, Sébastien; University of Bradford, AGES Knusel, Chris; University of Exeter, Department of Archaeology entheses, enthesopathy, Musculoskeletal Stress Markers (MSM), Keywords: senescence, activity, hormones, animal models, clinical studies http://mc.manuscriptcentral.com/oa Page 1 of 27 International Journal of Osteoarchaeology 1 2 3 Title: 4 5 Understanding Entheseal Changes: Definition and Life Course Changes 6 7 8 Short title: 9 10 Understanding Entheseal Changes 11 12 13 Keywords: entheses; enthesopathy; Musculoskeletal Stress Markers (MSM); senescence; 14 15 activity; hormones; animal models; clinical studies 16 17 18 Authors: For Peer Review 19 20 Villotte S.
    [Show full text]
  • Iliopsoas Tendonitis/Bursitis Exercises
    ILIOPSOAS TENDONITIS / BURSITIS What is the Iliopsoas and Bursa? The iliopsoas is a muscle that runs from your lower back through the pelvis to attach to a small bump (the lesser trochanter) on the top portion of the thighbone near your groin. This muscle has the important job of helping to bend the hip—it helps you to lift your leg when going up and down stairs or to start getting out of a car. A fluid-filled sac (bursa) helps to protect and allow the tendon to glide during these movements. The iliopsoas tendon can become inflamed or overworked during repetitive activities. The tendon can also become irritated after hip replacement surgery. Signs and Symptoms Iliopsoas issues may feel like “a pulled groin muscle”. The main symptom is usually a catch during certain movements such as when trying to put on socks or rising from a seated position. You may find yourself leading with your other leg when going up the stairs to avoid lifting the painful leg. The pain may extend from the groin to the inside of the thigh area. Snapping or clicking within the front of the hip can also be experienced. Do not worry this is not your hip trying to pop out of socket but it is usually the iliopsoas tendon rubbing over the hip joint or pelvis. Treatment Conservative treatment in the form of stretching and strengthening usually helps with the majority of patients with iliopsoas bursitis. This issue is the result of soft tissue inflammation, therefore rest, ice, anti- inflammatory medications, physical therapy exercises, and/or injections are effective treatment options.
    [Show full text]
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • OES Site Color Scheme 1
    Nuisance Problems You will Grow to Love Thomas V Gocke, MS, ATC, PA-C, DFAAPA President & Founder Orthopaedic Educational Services, Inc. Boone, NC [email protected] www.orthoedu.com Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Faculty Disclosures • Orthopaedic Educational Services, Inc. Financial Intellectual Property No off label product discussions American Academy of Physician Assistants Financial PA Course Director, PA’s Guide to the MSK Galaxy Urgent Care Association of America Financial Intellectual Property Faculty, MSK Workshops Ferring Pharmaceuticals Consultant Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. 2 LEARNING GOALS At the end of this sessions you will be able to: • Recognize nuisance conditions in the Upper Extremity • Recognize nuisance conditions in the Lower Extremity • Recognize common Pediatric Musculoskeletal nuisance problems • Recognize Radiographic changes associates with common MSK nuisance problems • Initiate treatment plans for a variety of MSK nuisance conditions Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response* When does the Inflammatory response occur: • occurs when injury/infection triggers a non-specific immune response • causes proliferation of leukocytes and increase in blood flow secondary to trauma • increased blood flow brings polymorph-nuclear leukocytes (which facilitate removal of the injured cells/tissues), macrophages, and plasma proteins to injured tissues *Knight KL, Pain and Pain relief during Cryotherapy: Cryotherapy: Theory, Technique and Physiology, 1st edition, Chattanooga Corporation, Chattanooga, TN 1985, p 127-137 Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc.
    [Show full text]
  • Atraumatic Bilateral Achilles Tendon Rupture: an Association of Systemic
    378 Kotnis, Halstead, Hormbrey Acute compartment syndrome may be a of the body of gastrocnemius has been result of any trauma to the limb. The trauma is reported in athletes.7 8 This, however, is the J Accid Emerg Med: first published as 10.1136/emj.16.5.378 on 1 September 1999. Downloaded from usually a result of an open or closed fracture of first reported case of acute compartment the bones, or a crush injury to the limb. Other syndrome caused by a gastrocnemius muscle causes include haematoma, gun shot or stab rupture in a non-athlete. wounds, animal or insect bites, post-ischaemic swelling, vascular damage, electrical injuries, burns, prolonged tourniquet times, etc. Other Conclusion causes of compartment syndrome are genetic, Soft tissue injuries and muscle tears occur fre- iatrogenic, or acquired coagulopathies, infec- quently in athletes. Most injuries result from tion, nephrotic syndrome or any cause of direct trauma. Indirect trauma resulting in decreased tissue osmolarity and capillary per- muscle tears and ruptures can cause acute meability. compartment syndrome in athletes. It is also Chronic compartment syndrome is most important to keep in mind the possibility of typically an exercise induced condition charac- similar injuries in a non-athlete as well. More terised by a relative inadequacy of musculofas- research is needed to define optimal manage- cial compartment size producing chronic or ment patterns and potential strategies for recurring pain and/or disability. It is seen in injury prevention. athletes, who often have recurring leg pain that Conflict of interest: none. starts after they have been exercising for some Funding: none.
    [Show full text]
  • 9 Impingement and Rotator Cuff Disease
    Impingement and Rotator Cuff Disease 121 9 Impingement and Rotator Cuff Disease A. Stäbler CONTENTS Shoulder pain and chronic reduced function are fre- quently heard complaints in an orthopaedic outpa- 9.1 Defi nition of Impingement Syndrome 122 tient department. The symptoms are often related to 9.2 Stages of Impingement 123 the unique anatomic relationships present around the 9.3 Imaging of Impingement Syndrome: Uri Imaging Modalities 123 glenohumeral joint ( 1997). Impingement of the 9.3.1 Radiography 123 rotator cuff and adjacent bursa between the humeral 9.3.2 Ultrasound 126 head and the coracoacromial arch are among the most 9.3.3 Arthrography 126 common causes of shoulder pain. Neer noted that 9.3.4 Magnetic Resonance Imaging 127 elevation of the arm, particularly in internal rotation, 9.3.4.1 Sequences 127 9.3.4.2 Gadolinium 128 causes the critical area of the cuff to pass under the 9.3.4.3 MR Arthrography 128 coracoacromial arch. In cadaver dissections he found 9.4 Imaging Findings in Impingement Syndrome alterations attributable to mechanical impingement and Rotator Cuff Tears 130 including a ridge of proliferative spurs and excres- 9.4.1 Bursal Effusion 130 cences on the undersurface of the anterior margin 9.4.2 Imaging Following Impingement Test Injection 131 Neer Neer 9.4.3 Tendinosis 131 of the acromion ( 1972). Thus it was who 9.4.4 Partial Thickness Tears 133 introduced the concept of an impingement syndrome 9.4.5 Full-Thickness Tears 134 continuum ranging from chronic bursitis and partial 9.4.5.1 Subacromial Distance 136 tears to complete tears of the supraspinatus tendon, 9.4.5.2 Peribursal Fat Plane 137 which may extend to involve other parts of the cuff 9.4.5.3 Intramuscular Cysts 137 Neer Matsen 9.4.6 Massive Tears 137 ( 1972; 1990).
    [Show full text]
  • Pes Anserine Bursitis
    BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Pes Anserine Bursitis ICD 9 Codes: 726.61 Case Type / Diagnosis: The pes anserine bursa lies behind the medial hamstring, which is composed of the tendons of the sartorius, gracilis and semitendinosus (SGT) muscles. Because these 3 tendons splay out on the anterior aspect of the tibia and give the appearance of the foot of a goose, pes anserine bursitis is also known as goosefoot bursitis.1 These muscles provide for medial stabilization of the knee by acting as a restraint to excessive valgus opening. They also provide a counter-rotary torque function to the knee joint. The pes anserine has an eccentric role during the screw-home mechanism that dampens the effect of excessively forceful lateral rotation that may accompany terminal knee extension.2 Pes anserine bursitis presents as pain, tenderness and swelling over the anteromedial aspect of the knee, 4 to 5 cm below the joint line.3 Pain increases with knee flexion, exercise and/or stair climbing. Inflammation of this bursa is common in overweight, middle-aged women, and may be associated with osteoarthritis of the knee. It also occurs in athletes engaged in activities such as running, basketball, and racquet sports.3 Other risk factors include: 1 • Incorrect training techniques, or changes in terrain and/or distanced run • Lack of flexibility in hamstring muscles • Lack of knee extension • Patellar malalignment Indications for Treatment: • Knee Pain • Knee edema • Decreased active and /or passive ROM of lower extremities • Biomechanical dysfunction lower extremities • Muscle imbalances • Impaired muscle performance (focal weakness or general conditioning) • Impaired function Contraindications: • Patients with active signs/symptoms of infection (fever, chills, prolonged and obvious redness or swelling at hip joint).
    [Show full text]
  • Gluteal Tendinopathy
    Gluteal Tendinopathy What is a Gluteal Tendinopathy? In lying Up until recently hip bursitis was diagnosed as the main Either on your bad hip or with bad cause of lateral hip pain but recent studies suggest that an hip hanging across body like so irritation of the gluteus muscle tendon is the likeliest cause. The tendon attaches onto a bony prominence (greater trochanter) and it is here that the tendon is subject to All these positions lead to increase friction of the tendon, compressive forces leading to irritation. can cause pain and slow the healing process. This can result in pain over the lateral hip which can refer down the outside For sleeping you might like to try these positions: of the thigh and into the knee. How common is it? Gluteal tendinopathy is relatively common affecting 10-25% of the population. It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60. One of the reasons for this is women It is also important to modify your activity. Avoid or reduce tend to have a greater angle at their hip joint increasing things that flare up your pain, this could be climbing stairs compressive forces on the tendon. or hills or those longer walks/runs. Signs and Symptoms Exercise Therapy • Pain on the outside of your hip, can refer down outside of the thigh to the knee This is best administered by a Physiotherapist to suit the • Worse when going up and/or down stairs individual but below is a rough guide to exercises which • Worse lying on affected side (and sometimes on the can help a gluteal tendinopathy.
    [Show full text]
  • Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)
    Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Original Effective Date 10/01/2019 Article ID Revision Effective Date A57079 N/A Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2018 American Medical Association.
    [Show full text]
  • The Anatomy of the Deep Infrapatellar Bursa of the Knee Robert F
    0363-5465/98/2626-0129$02.00/0 THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 26, No. 1 © 1998 American Orthopaedic Society for Sports Medicine The Anatomy of the Deep Infrapatellar Bursa of the Knee Robert F. LaPrade,* MD Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota ABSTRACT knee joint, and to define a consistent surgical approach to the deep infrapatellar bursa. Disorders of the deep infrapatellar bursa are important to include in the differential diagnosis of anterior knee pain. Knowledge regarding its anatomic location can MATERIALS AND METHODS aid the clinician in establishing a proper diagnosis. Fifty cadaveric knees were dissected, and the deep infrapa- Thorough dissections of the anterior aspect of the knee of tellar bursa had a consistent anatomic location in all 50 nonpaired cadaveric knees were performed. There were specimens. The deep infrapatellar bursa was located 27 male and 23 female cadaveric knees with 25 right and directly posterior to the distal 38% of the patellar ten- 25 left knees. The average age of the specimens was 71.8 don, just proximal to its insertion on the tibial tubercle. years (range, 42 to 93). After the skin and subcutaneous There was no communication to the knee joint. Its tissues of the anterior aspect of the knee were carefully average width at the most proximal margin of the tibial dissected away, an approach to the deep infrapatellar tubercle was slightly wider than the average distal bursa of the knee was made through medial and lateral width of the patellar tendon. It was found to be partially arthrotomy incisions along the patella, followed by compartmentalized, with a fat pad apron extending transection of the quadriceps tendon from the patella.
    [Show full text]
  • Imaging of the Bursae
    Editor-in-Chief: Vikram S. Dogra, MD OPEN ACCESS Department of Imaging Sciences, University of HTML format Rochester Medical Center, Rochester, USA Journal of Clinical Imaging Science For entire Editorial Board visit : www.clinicalimagingscience.org/editorialboard.asp www.clinicalimagingscience.org PICTORIAL ESSAY Imaging of the Bursae Zameer Hirji, Jaspal S Hunjun, Hema N Choudur Department of Radiology, McMaster University, Canada Address for correspondence: Dr. Zameer Hirji, ABSTRACT Department of Radiology, McMaster University Medical Centre, 1200 When assessing joints with various imaging modalities, it is important to focus on Main Street West, Hamilton, Ontario the extraarticular soft tissues that may clinically mimic joint pathology. One such Canada L8N 3Z5 E-mail: [email protected] extraarticular structure is the bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. The purpose of this pictorial essay is to characterize the clinically relevant bursae in the appendicular skeleton using diagrams and corresponding multimodality images, focusing on normal anatomy and common pathological processes that affect them. The aim is to familiarize Received : 13-03-2011 radiologists with the radiological features of bursitis. Accepted : 27-03-2011 Key words: Bursae, computed tomography, imaging, interventions, magnetic Published : 02-05-2011 resonance, ultrasound DOI : 10.4103/2156-7514.80374 INTRODUCTION from the adjacent joint. The walls of the bursa thicken as the bursal inflammation becomes longstanding.
    [Show full text]
  • Juvenile Spondyloarthritis / Enthesitis Related Arthritis (Spa-ERA) Version of 2016
    https://www.printo.it/pediatric-rheumatology/GB/intro Juvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA) Version of 2016 1. WHAT IS JUVENILE SPONDYLOARTHRITIS/ENTHESITIS- RELATED ARTHRITIS (SpA-ERA) 1.1 What is it? Juvenile SpA-ERA constitutes a group of chronic inflammatory diseases of the joints (arthritis), as well as tendon and ligament attachments to certain bones (enthesitis) and affects predominantly the lower limbs and in some cases the pelvic and spinal joints (sacroiliitis - buttock pain and spondylitis - back pain). Juvenile SpA-ERA is significantly more common in people that have a positive blood test for the genetic factor HLA-B27. HLA-B27 is a protein located on the surface of immune cells. Remarkably, only a fraction of people with HLA-B27 ever develops arthritis. Thus, the presence of HLA-B27 is not enough to explain the development of the disease. To date, the exact role of HLA-B27 in the origin of the disease remains unknown. However, it is known that in very few cases the onset of arthritis is preceded by gastrointestinal or urogenital infection (known as reactive arthritis). Juvenile SpA-ERA is closely related to the spondyloarthritis with onset in adulthood and most researchers believe these diseases share the same origin and characteristics. Most children and adolescents with juvenile spondyloarthritis would be diagnosed as affected by ERA and even psoriatic arthritis. It is important that the names "juvenile spondyloarthritis", "enthesitis-related arthritis" and in some cases "psoriatic arthritis" may be the same from a clinical and therapeutic point of view. 1 / 12 1.2 What diseases are called juvenile SpA-ERA? As mentioned above, juvenile spondyloarthritis is the name for a group of diseases; the clinical features may overlap with each other, including axial and peripheral spondyloarthritis, ankylosing spondylitis, undifferentiated spondyloarthritis, psoriatic arthritis, reactive arthritis and arthritis associated with Crohn’s disease and ulcerative colitis.
    [Show full text]